Organization
NORTH VALLEY PORTABLE X-RAY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN MARIE DAVIN HANCOCK CRT (OWNER)
(530) 895-3178
Entity
Organization
Contact information
Practice address
2095 RENZ RD, DURHAM, CA 95938-9627
(530) 895-3178
(530) 895-8731
Mailing address
PO BOX 1220, DURHAM, CA 95938-1220
(530) 895-3178
(530) 895-8731
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
FAC41966
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
630001123
RAILROAD MEDICARE
CA
01
—
XR0599660
MEDICAL
CA
01
—
ZZZ19531Z
BLUE SHIELD
CA
Enumeration date
11/17/2007
Last updated
08/25/2023
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